Abreu et al. Human Resources for Health 2013, 11:67http://www.human-resources-health.com/content/11/1/67

RESEARCH Open Access

A survey of the sociodemographic and educationalcharacteristics of oral health technicians in publicprimary health care teams in Minas Gerais, BrazilMauro Henrique Nogueira Guimarães Abreu1*, Carla Aparecida Sanglard-Oliveira1,Abdul Rahman Mustafá Jaruche1, Juliana Vaz de Melo Mambrini2, Marcos Azeredo Furquim Werneck1

and Simone Dutra Lucas1

Abstract

Background: To describe some sociodemographic and educational characteristics of oral health technicians (OHTs)in public primary health care teams in the state of Minas Gerais, Brazil.

Methods: A cross-sectional descriptive study was performed based on the telephone survey of a representativesample comprising 231 individuals. A pre-tested instrument was used for the data collection, including questionson gender, age in years, years of work as an OHT, years since graduation as an OHT, formal schooling, individualincome in a month, and participation in continuing educational programmes. The descriptive statistic was developedand the formation of clusters, by the agglomerative hierarchy technique based on the furthest neighbour, was basedon the age, years of work as an OHT, time since graduation as an OHT, formal schooling, individual income in a month,and participation in continuing educational programmes.

Results: Most interviewees (97.1%) were female. A monthly income of USD 300.00 to 600.00 was reported by 77.5% ofthe sample. Having educational qualifications in excess of their role was reported by approximately 20% of theparticipants. The median time since graduation was six years, and half of the sample had worked for four years as anOHT. Most interviewees (67.6%) reported having participated in professional continuing educational programmes. Twodifferent clusters were identified based on the sociodemographic and educational characteristics of the sample.

Conclusions: The Brazilian OHTs in public primary health care teams in the state of Minas Gerais are mostly femalewho have had little time since graduation, working experience, and formal schooling sufficient for professional practice.

Keywords: Dental auxiliaries, Dental hygienists, Oral health technician, Socioeconomic factors, Educational profile

BackgroundThe evaluation of the dental workforce globally is an im-portant and actual issue. There are two kinds of auxiliarydental personnel in Brazil, oral health technicians (OHTs)and dental assistants. Within the context of health carework, the OHT contributes to integral patient care in boththe private and public settings of the health care system byacting to support diagnosis, education on health, protec-tion, prevention, recovery, rehabilitation, and health man-agement. The OHT plays a crucial role in the promotion,

* Correspondence: maurohenriqueabreu@ig.com.br1Universidade Federal de Minas Gerais, Avenida Antônio Carlos, CEP:31270-901, 6627 Belo Horizonte, BrazilFull list of author information is available at the end of the article

© 2013 Abreu et al.; licensee BioMed Central LCommons Attribution License (http://creativecreproduction in any medium, provided the or

prevention, and recovery of oral health at the individualand collective levels in the public and private settings.Dental assistants have less function in health care set-tings than OHTs, devoting more time to dental healthpromotion activities than to helping perform dental taskswith individual patients. Although accepted as an occu-pation since 1975, OHTs were only regulated in Brazilin 2008. According to this regulation patients cannot ac-cess OHTs directly for a diagnosis and treatment planand for the few activities in which OHTs work directlywith the oral cavity of the patient, the direct supervisionof the dentist is mandatory. OHTs should have at least11 years of formal education. Beyond clinical work,many community actions could be developed by these

td. This is an open access article distributed under the terms of the Creativeommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andiginal work is properly cited.

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professionals [1,2]. Brazilian OHTs from Minas Geraishave worked more with preventive/collective activitiesthan in individual clinical care [3].In other countries [4,5], professions with job descrip-

tions similar to that of the OHT have been assessed asto their sociodemographic and educational characteris-tics. Given the importance of human resources in thenational health care system [6], such information is rele-vant for the planning of policies for health care humanresources.The present research study seeks to examine the

sociodemographic and educational characteristics of arepresentative sample of OHTs in the state of MinasGerais, Brazil. During the year when the present studywas conducted, the state of Minas Gerais hosted ap-proximately one-third of all OHTs in the Family HealthStrategy (FHS) [7]. The latter is the country’s primaryinstrument for providing basic care to the populationin Brazil [8]. Therefore, the present study is relevantfor the Brazilian public health system (Unified HealthSystem) [9], as more thorough knowledge of this humanresource is crucial for the effective planning and man-agement of primary health care. In addition, it mightrepresent an effective contribution to the knowledge ofpersonal and regional characteristics of OHTs, thusstrengthening the theoretical-practical coherence of thework process. Besides, in Brazil, no such studies havebeen conducted with representative samples of OHTs.The availability of rigorous quantitative surveys of healthcare occupations could be useful in identifying appropri-ate solutions for human resources for health planningand management [10]. Health actions and health evalu-ation should consider the profile of health professions.Thus, the evaluation of personal characteristics of OHTscould be useful for a broader and better knowledgeabout their potential labour force in the FHS.As a function of the new legislation for OHTs in Brazil

and the relevance of such professionals for the rationaleof the organization of the work process, especially withinthe context of the Unified Health System, the aim of thepresent study was to describe some sociodemographicand educational characteristics of Brazilian OHTs inpublic primary health care teams in the state of MinasGerais.

MethodsMinas Gerais state is the second most populous state inBrazil with 19,597,330 inhabitants in 2010, with a popu-lation growth of 9.51% in the last ten years.Structured interviews were conducted by telephone

with OHTs enrolled in the FHS of the state of MinasGerais [11]. The OHTs’ names and workplaces were lo-cated through the website of the National Register ofHealth Institutions, which also supplied the number of

dental teams that included an OHT registered with theFHS in the state of Minas Gerais for calculation of thesample size.A questionnaire was elaborated based on a pre-

existing instrument [12] that was adapted for the pur-pose of the present study and according to the attributesestablished by the law regulating the OHT profession inBrazil. The sociodemographic and educational variablesassessed were the following: gender, age in years, yearsof work as an OHT, years since graduation as an OHT,formal schooling, individual income in a month, and par-ticipation in continuing educational programmes (yes/no).The instrument’s reliability was assessed by means of atest-retest conducted by telephone with 20 OHTs in theFHS of the state of Minas Gerais who were selected in asimple random manner. Agreement was estimated usingthe Cohen’s kappa statistic (categorical variables) and theintraclass correlation coefficient (quantitative variables)using the Statistical Package for the Social Sciences (SPSSfor Windows, version 18.0; SPSS Inc, Chicago, IL, USA)software. Kappa coefficient values higher than 0.60 wereconsidered to be adequate. Kappa values were lower than0.60, that is, with low reliability, in only 5% of the ques-tions, which were thus reformulated and tested anew with12 additional randomly selected OHTs. The data werethen reanalysed, and the results showed kappa valueshigher than 0.60 for all the questions. The intraclass cor-relation coefficient of the quantitative variables variedfrom 0.99 to 1, and no further measurements were there-fore needed. Thus, the questionnaire was rated as appro-priate for measuring the study variables.The questionnaires were applied by telephone. The

OHTs responded to the questionnaire at their workplaceor another location on the date and time that theyjudged to be the most convenient. At the beginning ofthe interviews, the purpose of the study was explainedto the participants, and the text of the free and informedconsent form was read aloud by the interviewer.The population (N = 545) was the same as the number

of FHS dental teams that included an OHT in the stateof Minas Gerais listed in the National Register of HealthInstitutions in May 2010. The latter is a national recordof all health units linked to the Unified Health System[13]. The names of repeated OHTs and those who par-ticipated in the pilot study were excluded; therefore, thefinite population of OHTs was 484.The sample size was calculated based on a 50% ex-

pected frequency, 95% confidence interval, 5% precision,and finite population of OHTs equal to 484. Thus, thesample comprised 231 OHTs who were selected in asimple random manner.From the 231 OHTs who composed the initial sample,

27 were lost for analysis (response rate = 88.3%) dueto the following reasons: no longer working for the FHS

Table 1 Descriptive analysis of sociodemographicvariables of OHTs, Brazil, 2010

Variables (n = 204) % (95% CI)

Female 97.1 (93.4 to 98.8)

Up to 11 years of formal schooling 79.9 (73.6 to 85.0)

Participation in continuing educational programmes 67.6 (60.7 to 73.9)

Individual income in a month

Up to $300.00 4.9 (2.5 to 9.1)

$300.00 to $600.00 77.5 (71.0 to 82.9)

More than $600.00 17.6 (12.8 to 23.7)

Age in years (minimum; median; maximum)a 22; 36; 55

Years of work as an OHT (minimum; median;maximum)a

0; 4; 20

Years since graduation as an OHT (minimum;median; maximum)a

1; 6; 25

aNo quantitative variable had a normal distribution (Kolmogorov-Smirnovtests; P <0.05). CI, confidence interval; OHT, oral health technician.

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(n = 12); refusal to participate in the study (n = 4); andimpossibility to establish contact (n = 11). Therefore, thefinal sample comprised 204 OHTs, and the recalculatedprecision was 5.21%.The data were analysed using the SPSS software for

Windows, version 17.0. The descriptive statistics in-volved a proportion calculation, central tendency mea-sures, and 95% confidence intervals. The assumptions ofnormality for numeric variables were evaluated with theKolmogorov-Smirnov test. The clustering was based onage (in years), years of work as an OHT, years sincegraduation as an OHT, formal schooling (incompleteprimary education; complete primary education; incom-plete secondary education; complete secondary educa-tion; incomplete university level; complete universitylevel), individual income in a month (categorized accord-ing to the Brazilian minimum wage), and participationin continuing educational programmes (the question was:‘Do you attend any continuing educational programmes inthe dental field?’ yes/no). The first three numeric variableswere dichotomized regarding their median values. Formalschooling was dichotomized based on the minimum edu-cation needed to be an OHT (complete secondary educa-tion, that is, 11 years). Three types of clusters (of two tofour clusters) were formed from the 204 OHTs in MinasGerais. The choice of two clusters was due to a better un-derstanding of the phenomenon (sociodemographic andeducational characteristics). The multivariate agglomera-tive hierarchy technique based on the furthest neighbourwas used for the cluster analysis (CA), which is an ex-ploratory data analysis tool for organizing observed data(in our case, OHTs) into groups (clusters), based on com-binations of independent variables (in our case, sociode-mographic and educational characteristics of OHTs), andmaximizes the similarity of cases within each cluster whilemaximizing the dissimilarity between groups. This multi-variate analysis creates new groupings without any pre-conceived notion of what clusters may arise. This datareduction makes it easier for the management of sub-groups. One of the difficulties of CA is to identify thenumber of clusters. In our study, as described previously,the choice of two clusters was due to a better understand-ing of the phenomenon. Clusters are also interpretedbased solely on the variables included in them [14].The study was submitted to and approved by the Ethics

Committee for Human Research of the Federal Universityof Minas (Universidade Federal de Minas; protocol number0027.0.203.000-10).

ResultsThe overall description for each variable showed that re-garding the sociodemographic variables, 97.1% of theOHTs were female (95% CI: 93.4 to 98.8%) and the sameproportion graduated in OHT. The age range was 22 to

55 years, while 50% of the OHTs were 36 years old oryounger. The monthly income of most OHTs (77.5%;95% CI: 70.9 to 82.8%) varied from BRL 510.00 (USD300.00) to BRL 1,020.00 (USD 600.00), whereas it was lessthan BRL 510.00 (USD 300.00) in less than 5% of the sam-ple and higher than BRL 1,020.00 (USD 600.00) in 17.6%(95% CI: 12.8 to 23.7%). Regarding the educational level,79.9% of the participants had up to 11 years of formalschooling. The time since graduation varied from one to25 years, with a median of six years. A total of 67.6% of in-terviewees (95% CI: 60.7 to 73.9%) reported having partici-pated in continuing educational programmes in dentistrywhile working as an OHT at the FHS. Their work experi-ence as an OHT varied from zero to 20 years, while 50% ofthe interviewees had worked for four years as an OHT(Table 1). The sociodemographic and educational charac-teristics in each cluster are presented in Table 2.

DiscussionOur results show that most of the interviewed OHTswere female (97.1%), which agrees with the findings ofother studies conducted with health care professionals[6] and auxiliary oral health professionals [4,5]. There isa historical process of feminization of the oral healthprofessions [15]. However, in the auxiliary oral healthprofessions, we could not say that there is a process offeminization, since it has always been a feminine profes-sion, almost everywhere. In 1910, Alfred Fones devel-oped the first training programme for young women,whom he called ‘dental hygienists’ [16,17]. From that timeonwards, the profession has included mainly females dueto historical and cultural reasons relative to the workorganization and the devaluation of the profession itself[15]. Despite this, there is a huge salaries variation in the

Table 2 Sociodemographic characteristics of OHTs from the two clusters, Brazil, 2010

Variables Cluster 1 (n = 159) Cluster 2 (n = 35)

% (95% CI) % (95% CI)

More than 11 years of formal schooling 14.5 (9.6 to 20.6) 45.7 (29.9 to 62.2)

Participation in continuing educational programmes 66.7 (59.1 to 73.7) 77.1 (61.2 to 88.8)

Individual income in a month

Up to $300.00 6.3 (3.2 to 10.9) 0 (0 to 8.2)

$300.00 to $600.00 93.7 (89.1 to 96.8) 0 (0 to 8.2)

More than $600.00 0 (0 to 1.9) 100 (91.8 to 100)

More than 37 years old 30.2 (23.4 to 37.7) 88.6 (74.7 to 96.3)

More than four years of work as an OHT 34.6 (27.5 to 42.2) 65.7 (49.0 to 79.9)

More than six years since graduation as an OHT 37.7 (30.5 to 45.5) 91.4 (78.4 to 97.8)

CI, confidence interval; OHT, oral health technician.

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public sector, since it depends on the local policies and car-eer plans from the municipalities, and in our research,82.4% of OHTs perceived less than the mean income ofthe personnel without higher education in public sector[18]. Two bills on wages of technical professions inhealth care are under evaluation by the Brazilian NationalCongress. The proposed wage for an OHT is less than ahalf of the proposal of the nursing technician. Thus, themonthly wage of an OHT provides further proof of the lit-tle value attributed to this profession [19,20].The age profile of the study sample, which is associ-

ated with the years since graduation and work as anOHT, indicate a relatively young group of people with apotentially long future in the profession. In our study,there are a few OHTs (n = 3; 1.5%) who reported lessthan 11 years of formal schooling (data not shown). Thishappened probably because the legislation is recent andsome OHTs may have been formed in the health serviceitself. The percentage of OHTs with incomplete orcomplete university level (more than 11 years of formalschooling) indicates the phenomenon of overeducation,that is, having educational qualifications in excess of theirrole [21]. Despite being formally prepared for professionalpractice, the educational qualifications in excess of theirrole might paradoxically suggest a possibility to changeprofessions. The reasons for leaving the dental workforcemay involve a complex net of reasons [22] and should beaddressed by future research. On the other hand, we couldnot discard the possibility of this phenomenon which mayrepresent opportunities for the further professionalizationof this sector of the dental team.The time since graduation and work experience as an

OHT of the present sample correspond to the first dec-ade of the 21st century. Indeed, most Brazilian OHTsgraduated between 2004 and 2009, which is possibly dueto the influence of the National Policy of Oral Healththat was launched in 2004. The policy establishes thejoint collaboration of the human resources at the FHS,

and within this context, the OHTs play a key role in in-creasing the access to health care services through ac-tions of prevention, promotion, and clinical assistance[2,23]. Different from other countries [2,24], the OHTsin Brazil are widely incorporated into the public sector,which might explain the findings.The participation in continuing educational programmes

show that the OHTs seek to remain up-to-date on thepractice of their profession. The participation of hy-gienists in this type of training was also assessed in othercountries [25,26].The identification in the present study of two OHT

clusters based on the assessed variables indicates somefindings that might be useful in the planning of policiesof human resources. Compared to cluster 2, cluster 1was composed of younger OHTs with less time sincegraduation, working experience, income, and schooling.On the one hand, the characteristics of cluster 2 couldshow that this profession appears to allow for educa-tional and income growth. It was expected that the OTHswith more time of working experience and age have moreopportunities to participate in continuing educational pro-grammes and to have higher salaries, particularly if theywork in the public sector. In general, the Brazilian publicsector provides career plans and/or permanent job oppor-tunities. In consequence, more time of work means moreadvantages with respect to salaries and the opportunitiesto have continuing education. On the other hand, thepresence of a group of individuals who could desire a shiftto other professions requiring higher educational qualifica-tions after a few years of practice might represent a causefor concern. This phenomenon might be explained by thelow value attributed to and historical conflicts faced bythis profession in Brazil [1,2]. Further research about turn-ing over of this profession in the public sector is needed.The differences in formal educational between the clusterscould not be explained by a change in entry bar. TheBrazilian law maintained the old obligation of at least

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11 years of formal educational for being an OHT. Al-though cluster 2 comprised a lower number of OHTs, onemight infer that cluster 1 would exhibit characteristicssimilar to those of cluster 2 in the near future, unless thehistorical conflicts in the professionalization [2] are solved.It is important to discuss the profile of OHTs in Brazil

in relation to dental auxiliaries or mid-level providers inother countries. Brazilian law prohibits OHTs from exer-cising their activities in an autonomous fashion. Besides,dental corporative interests exert an influence overprofessionalization of OHTs, especially in discussions re-garding the permissible activities of these professionalsin the oral cavity of patients [2]. Empirical data showsthat Brazilian OHTs from Minas Gerais have spent moretime in community actions than in individual clinicalcare [3]. This is not the reality of dental auxiliaries inother countries [27-29] who have permission to performclinical procedures even without the supervision of thedentist. They can even set up their own offices and ex-clusively offer dental hygiene services [2,27-29]. The so-cioeconomic and educational characteristics of BrazilianOHTs may be explained by their professional context.It is worth noting that the data collected in the present

study were provided by the OHTs’ self-reports. The diag-nosis of public health issues might be established by quan-titative and/or qualitative methods. The methodologicaloption for a quantitative theoretical framework in thepresent study does not deny the urgent need for qualita-tive studies, which allow an assessment of the full com-plexity of the work process. Currently, as the organizationof primary health care in Brazil is based on the FHS andperson-centred assistance [26], the role of OHTs must beassessed and most likely reformulated. Other quantitativeresearch could be developed using more sociodemo-graphic and educational variables. Nevertheless, the quanti-tative methods are useful to approach wide-encompassingphenomena with probabilistic representativeness. The sam-pled OHTs were geographically distributed in a very similarway to the population of OHTs in Minas Gerais (data notshown). The distribution of our sample reaffirms the exter-nal validity of our study. Other surveys conducted at thenational level are also important. Although the telephonicsurveys might produce results that are different from thoseachieved by other methods, they are valid, and their viabil-ity is satisfactory, especially for the assessment of healthcare services. In the present study, the method used exhib-ited adequate reproducibility, and as mentioned above, it isconsidered to be valid by several studies in the field of pub-lic health and social sciences [10,30-33].

ConclusionsThe Brazilian OHTs included in the FHS in the stateof Minas Gerais are mostly female who have had littletime since graduation, working experience, and formal

schooling sufficient for professional practice. There weretwo different clusters of OHTs with differences in sociode-mographic and educational characteristics.

AbbreviationsCA: Cluster analysis; CI: Confidence interval; FHS: Family health strategy;OHT: Oral health technician.

Competing interestsThe authors declare that they have no competing interests.

Authors’ contributionsMHNGA conceived of the study and participated in its design and coordination.CASO performed the literature review and data collection and participated inthe conception and design of this study. ARMJ performed the literature reviewand construction of the data bank. JVMM performed the literature review andthe statistical analysis and interpretation. MAFW and SDL participated in theconception and design of the study. All authors helped to draft the manuscriptand read and approved the final manuscript.

AcknowledgementsThis manuscript was sponsored by the Foundation for Research Support ofthe State of Minas Gerais (Fundação de Amparo à Pesquisa do Estado deMinas Gerais, FAPEMIG) and Pro-Dean of Research at the Federal Universityof Minas Gerais (Pró-Reitoria de Pesquisa da Universidade Federal de MinasGerais). MHNGA is a fellow of the National Council for Scientific andTechnological Development (Conselho Nacional de Desenvolvimento Científicoe Tecológico, CNPq). The authors would also like to thank the reviewers for thequality of the requests made in the evaluation process of this article.

Author details1Universidade Federal de Minas Gerais, Avenida Antônio Carlos, CEP:31270-901, 6627 Belo Horizonte, Brazil. 2René Rachou Research Center,FIOCRUZ, Avenida Augusto de Lima, CEP: 30190-002, 1715 Belo Horizonte,Brazil.

Received: 6 August 2013 Accepted: 11 December 2013Published: 23 December 2013

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doi:10.1186/1478-4491-11-67Cite this article as: Abreu et al.: A survey of the sociodemographic andeducational characteristics of oral health technicians in public primaryhealth care teams in Minas Gerais, Brazil. Human Resources for Health2013 11:67.

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